Health Editor, Sydney Morning Herald

So-called "Premenstrual Dysphoric Disorder" (PMDD) has been listed as a condition warranting further study for a while now, but it looks like the powers that be are graduating it to a full-grown mental illness.

You know how sometimes you just go a little bit crazy when you have your period? Well, it turns out PMS is about to become a mental illness.

So-called Premenstrual Dysphoric Disorder (PMDD) has been listed as a condition warranting further study for a while now, but it looks like the powers that be are graduating it to a full-grown mental illness.

Allen Frances is a respected US psychiatrist who led the creation of the current edition of the manual. He has become a fierce critic of the proposed changes because he believes it is medicalising normal behaviours.

A lot of women experience symptoms when they have their period, but does that make them mentally ill and in need of treatment (in particular, in need of antidepressants)?

Frances worries those fuzzy edges on the boundaries of normal are about to become a whole lot fuzzier, and while drug companies might end up getting a lot more cash it’s not going to do a whole lot of good for anyone else.

But Nada Stotland, a former president of the American Psychiatric Association (the body that creates the manual), sees something even deeper at work when it comes to this particular diagnosis.

In turning really bad PMS into PMDD she argues we will further embed a cultural stereotype that says men’s bad moods or grumpiness are reasonable expressions of their feelings but when women are grumpy it must be PMS, unrelated to their life circumstances.

This is a shortened version of her argument made in a Psychiatric Times podcast that is worth listening to in full:

“My feeling is that having this diagnosis in the DSM would be bad for women. Most Americans believe that the menstrual cycle causes deleterious changes in women’s mood and behaviour…. [and] they reflexively attribute all such behaviour to the menstrual cycle. Well women in our society still bear a disproportionate share of domestic and dependent care responsibilities, society provides little support and little respect for those responsibilities, women are still paid les for the same work, women are grossly underrepresented in positions of leadership and authority but at the same time women are expected to be pleasant and compliant all the time the anger and irritation you could expect given the situation I’ve described are not accepted, as men’s anger and irritation are, so when depression ensures or irritability erupts women therefore need an excuse and PMS fits the bill.”

Perhaps your hormones do make you feel a lot more emotional than usual, but isn’t it generally about things that bother you anyway? And while some women do have really terrible symptoms, is there really enough evidence to show that some are suffering from a mental illness while others just have plain ol’ PMS? And does this justify creating a diagnosis that has the potential to re-enforce cultural stereotypes as well as increasing unnecessary medication use?

Stotland doesn’t think so, and neither do I. But then again, maybe I’m just PMSing.

Allen Frances is doing a series of public lectures around Australia on “saving normal” and the boundaries of psychiatry.

∙ TONIGHT he will give a talk for St Vincent’s Hospital and the Garvan Institute in Sydney. 5pm for a 5:30pm start. Garvan Lecture Theatre, Burton St, Darlinghurst. Entry by gold coin donation.

∙ On July 5th he will be at Flinders University in Adelaide. Room 1, Level 1, Flinders University Victoria Square, 182 Victoria Square, Adelaide, SA, 5000, Australia. Entry is free. 6pm to 7:30pm.

29 comments

I understood that Drs in the US are simply trying to get a variety of conditions added to DSM IV to ensure their wacky health insurance system covered the condition's diagnosis and treatment. It is an administrative fiction to somehow make their health system fairer. Doesn't mean we have to buy into it.

Commenter

chi chi

Location

richmond

Date and time

June 19, 2012, 9:02AM

As someone who suffers from well-above-average PMS (as a result of my endometriosis), I'm of two minds about this.

Firstly, I know that my symptoms really do affect my life and that I am apt to react in a way that is completely out of the ordinary when I'm in the grips of my PMS. I've had it affect my work life, because I've over-reacted to a situation, or cried inappropriately. I actively structure my life to avoid situations where it will be a problem. It's a real issue for me, and there's a part of me that is pleased that the medical profession is starting to take it seriously, rather than dismissing it as "women's issues".

On the other hand, your point that this just further stigmatises the problem as a "mental illness" also concerns me, because my PMS doesn't stem from a chemical imbalance in my brain, but in my reproductive system. It just happens to also affect my emotions. I don't know enough about mental illness to know for sure, but I've never been tempted to try to treat my problems with anti-depressants, because it seems like that would just mask the underlying hormonal problem.

Commenter

Linda

Date and time

June 19, 2012, 9:14AM

Rape is set to become a mental disorder!? What on earth!? So does that mean rapists could avoid sentencing or conviction on the basis of mental disability? That seems like a very very dangerous road to go down...

Commenter

rah rah

Date and time

June 19, 2012, 9:15AM

but rape is obviously an expression of a disordered, potentially sociopathic mind. Drug them into insensibility and chemically castrate I say ;-)

Commenter

crowgrrl

Date and time

June 19, 2012, 1:49PM

Really disturbing, especially the idea of making sexual assault and rape 'mental illnesses'. It seems to me that rather than getting men locked up indeterminately, this will serve as a very handy excuse to get them off the hook. 'I couldn't help it your honour, I have a mental illness'. It's hard enough getting a rape conviction as it is.

Commenter

Mel

Date and time

June 19, 2012, 9:26AM

A husband or boyfriend would be mad to not understand when his partner has PMS. Maybe that could be added to the madness list?

Commenter

Smart husband

Date and time

June 19, 2012, 9:27AM

Agreed! When their overy equilivant feel like they are being ripped inside out they might find they're quite irratable as well!

Commenter

alice

Location

sydney

Date and time

June 19, 2012, 3:19PM

This is a pretty interesting article, DSM V is certainly slated to have some controversial changes included. I'd like to suggest that you temper your headline though Amy, 'madness' is a term that has not been used by health professionals for quite some time. It belittles an otherwise thoughtful article.

Commenter

not my real pseudonym

Location

Sydney

Date and time

June 19, 2012, 9:40AM

"A lot of women experience symptoms when they have their period"Firstly, let me get my pedantic comment out of the way. It's PMS, as in PREmenstrual stress, 'pre' meaning coming before. In other words, women, do not have PMS while on their period, they have it in the days leading up to their period. I'm not denying some women may be grumpy while on their period, but whatever that is, it's not PMS.

Now to address the topic. Mild PMS isn't a big deal, but some women have raging PMS which seriously affects all aspects of their life, why shouldn't this get treated like any other serious emotional issue?

Commenter

Judy

Date and time

June 19, 2012, 9:56AM

As someone who has PMDD, I am really upset by this article. It basically says I just have PMS and am not woman enough to deal with it. I used to have PMS, and that is nothing! Pain, cramps, headaches, irritability etc. Notihng!! After I had my daughter, I started suffering from PMDD, although it took them 3 years to diagnose it. And in those 3 years, they first thought I had post natal depression, then they thought I had an anxiety disorder, before they finally realised it was PMDD. This shows you how much the symptoms mimic other mental disorders. They finally asked me to do a diary of symptoms, where they discovered that the symptoms revolved around my period, leaving me about 8 days a month symptom free. Some symptoms are severe anxiety, hot flushes, vomiting, diarreah and sleeplessness. If I'm not medicated I have vomiting and diarreah for a third of the month, meaning I weigh nothing and am undernourished, having to be hospitalised. I will sleep only about an hour per night. Even when I am medicated I still get the symptoms in a mild form. This is not PMS!!! The medication I'm on causes extreme tiredness meaning I have trouble looking after my daughter, I've put on 20kgs because it slows metabolism which means I am depressed about my weight, and I can't have children while on the medication, which means my plans to have 3 kids has been completely halted. At the moment there is only a few doctors specialising in this and not much research being done. If it is added to the DSM then people like me can get more help. Please do more research, perhaps talk to people with the problem before you use your influence to affect peoples opinion.